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tv   [untitled]    August 17, 2014 7:30pm-8:01pm PDT

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that this effort is shaping up and the kind of leadership that you are demonstrating and we think that there is, and are elements of this that we can bring to it and that will help move the program, along. and there has been initiatives that the labor has taken in the past, such as health and safety, and the members will seem logical but it takes the labor a while to figure it out and to get behind it and to start devoting resources to it. and i believe that wellness is one of those areas, that we have been slow, to get to. and to understand, the value of it in terms of the health and more of the issue and the health of our members being a priority for the labor and so i think that we are there. and we are following the example that you are setting seeing the work that you doing and going to come in to the extent that we can to provide the organizational access. and communications and other things that we do, pretty well to help to support the effort that you are making. and so we are very excited about that and devoted to
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trying to make this successful. and before i sit down, i should say, we are some what sorry that we were not here when the rates were set. and you know, usually, people show up when there is good news and you can't find it when there is bad news. for some reason, some of the months and something, we were just not around and paying attention when the new rates were set and it is something that all of us, should be proud of, and certainly, hss and demonstrating reducing the rates, which among other things, is the right thing to do for the taxpayers, but also, it helped to cross the major driver against the wage increases and so it is a big hurtle that you hear. and trying to negotiate a new rate. and so it is a very important area for us and it is okay to miss the boat and not realize that you missed the boat is a lot worse. and we feel that we missed the boat. we should have been here to congratulate you to the new rates and to thank you and your
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staff for that leadership. if it makes you feel better, we were not at the board of supervisors either, when they adopted the rate. and they could be. >> and universally ignored. >> yes, they could not understand, why a year ago they had hundreds of people in the audience, and the rates were going down, and no one was there. >> so my apologies. >> thank you. for your comment. >> anyone else? >> great. >> all right. thank you very much. >> next item, please? >> item 5, discussion item. hss financial reporting as of may, 31, 2014, pamela. >> the report of the actual
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revenues are reported based on the activity, june 8, 2014. but the projection are based on activities through june 30th. in terms of the trust, tp&g started the audit and until that is started in mid october the numbers will not be final and we usually have them come in november to present the financial audit. and in terms of the general fund budget, the books are still open, and we are in, what is called the 13th month. and in there is also a 14th month and so the 13th month, there really is just the balance sheet types of adjustments, that this is almost where we have all of the final entry and there is still probably a few that are not. and so the numbers are not completely final. and in terms of the assets for the trust fund, based on the
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activity through may, 2014, we project a 12.8 million increase in the trust fund and as always, it is contribution receivables and assets and unearned and liabilities and compared to last meeting, which would be june, this is 4.7 million less than the balance. and as i mentioned before, this does bounce around based on activities and that happened and entries and pay ables and expenses paid, to the health plan. >> the main assets available in the trust fund were 77.4 million on june 30, 2013 and based on this projection, it would increase to 90.2 million. and the projected increased of
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the assets are primarily due to 10.1 increase in the projected city planning assets and 4.6 million increase in estimated favorable claims experience in the self-insured dental plan. and other factors that contributing to the 12.8 million are associated with unfavorable claims in the blue shield flex fund and increase in the estimated net, and medical and hmo insurance and premium revenues and surplus of sf as and reductions over claims and the estimated increase in the 205 budget and the increase for interest, and performance guarantee and the forfeit turs played by blue shield and the reduction of the transfers into the general fund, in terms of the general fund, and administrative
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budget, based on the results of the first eleven months, this is again, is the fact that we are equally included at this point to 12 months, but the things bounce around a little bit and there is a balance of 908,000 dollars for the end of the year and now this is really unprecedented. don't get excited that we will not have this next this current fiscal year. we have had a significant amount of hires that were delayed, and that is rebuilding in about, 619,000 dollars of lower expenditures for personal services and benefit and we are staffing up. and we expect to be at staffing levels, of positions approved through the end of 2013, 14, and we expect to be there the
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end of october, and then, we start for the hiring for the new positions that are approved in the current year's budget, and all of those were moved by the budget process to being effective january first. and we are or have talked to the controller's office and the mayor's office about exceling some of those so that we are on board, january first. but, you know, there is a significant challenge with the whole process. and then we also have 289,000 balance in non-personal services and other services of other departments commonly known as work orders. and we are planning to request the care for of the remaining balances of that $208,000. and we have still money that we owe for various contracts and
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for the improvements. and you know, establishment of the wellness center. i'm happy to entertain any questions that you have? pamela, could i just put in my pitch, whatever value that it adds to do the recruiting before january first, if you are not allowed to start the recruiting for those positions until january first we will be in this position again and what we know is that our staff are really critical to providing great services to our members. and we really really urge the city to allow the recruitment to happen, so that they are ready to aboard, and i guess that it would be january second. >> when the combination of the parties that governor our budget convened and moved the positions to january first, that were very critical and we pushed hard that that would occur and i got concur ans for
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that from the deputy controller when they were sitting in our hearings. and so the big thing is carving out enough time to put the job descriptions togethers. >> any other comments from the commissioners? >> commissioner scott, i would like to take this particular occasion to commend pam on her leadership and diligence. through what i think that i could best describe as being a labyrinth of a budget process here in the city. we all had the thing to flare up about staffing, and classification reductions and done in a very arbitrary and capricious way by a financial colleague. but i think that at the end of the way, your professionalism and your hard work, and i know that you spent, many, many hours, revising, and tables, and doing new calculations, and all of the rest of it. it needs to be called out particularly, at this point in
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time and so i thank you for that. as a member of the finance committee. and i kind of walked through the process and only saw, a very small part of it. and the living nightmare of the past few months. so, thank you, for what you have done for all of us. >> you know, a budget is only a plan. you know, and then you have to make assumptions. we are realizing and i knew this basically from the beginning of traying to establish a form of budget process within the department, that there would be more work that would need to be done this year, to be able to really justify all the funds not just the new funds, that we are asking for, so that we have a really good plan. and people can realize, you know, that we are ongoing money for this and our new money is for that and have it all documented but it is a, it is a
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plan in progress. >> thank you. >> thank you. >> any other questions or comments? >> do you want to introduce your new staff member? >> yes, i want to introduce, david and he came over from the human service agency. and he is our new contract's manager and he will be helping me in negotiating considers and working with the vendors. and i am so thankful that he is here, really, i needed some help. and we hoped that you know, his forte is really putting things together, and solving some of those you know, unclear service things that we have within the document and on the contract side and i have been trying to do it on the finance side and we are excited about having him here. >> welcome. >> and can i also just point out that pamela is now in the midst of not only dealing with the external audit but with the requirement to turn in a 1.5
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percent budget decrease and then in anticipation of the new ballot proposition that was put on the ballot and so that money that we got back, half of it is going away again. >> maybe. and depending on what happens in november. but, she is crafted several scenarios and we walked through them yesterday, and we are just lucky to have someone who can figure out all of the different places we can put things and move things. so that we can don't damage the core structure. and so i am grateful for that, but we should hopefully we will not have to cut it. >> so, just to go back to that, thank you for bringing it up. i don't know how much background you have in this, but there was a ballot initiative placed on the ballot, at the last minute after the budget was already
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crafted. that would provide funding to muni and increase in population and this will effect the general fund by about 20 million dollars. and so every department has to come in, and in the general fund, and it is about 45,000 and this will only be triggered if the proposition passes and as you know there is a lot of financial propositions on the budget, or in the election, and it may be a challenge to see what will be voted on. they are looking on ongoing cuts, and so we are trying to figure out how we don't effect the fact that we have or we needed staff, and we need to maintain many of our really critical contracts, for,
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including aon for the actuals. and so, as katherine mentioned, we did go over some scenarios, and i been tolds to go back to the numbers, and we will work out something that the actual plan has to be submitted to the mayor by the end of next week. >> great. thank you for your work on that. >> any other commissioner comments? >> any public comment on this item? >> thank you. >> next item pleased. >> >> item 6, discussion item. presentation of the uhc audit, aon hewitt.
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>> i am here to highlight the 2014 claim audit that we performed at the united healthcare. we start out with the plan evaluation and the methodology and we look at 220 claims, and medical claims. and in addition, we also had ten targeted claims, for high dollars, and the claims paid over 50,000 and ten claims, for disease, and our errors are categorized into two section and we have payment error and non-payment errors. our results will be based on financial and payment accuratecy as well as turn around time and how well they
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are processing the claims in 14 calendar days and in 30 calendar days. >> you don't mind, i am going to interrupt you with a question and i ask commissioners as we go along, okay. you said that you obtained the payment and non-payment errors and you measure on financial over all and payment and i am confused to the financial and payment. >> okay, so financial errors are going to look at the financial impact of the audit. and the payment errors are the frequency of errors. so the financial errors are going to look only at the financial aspect >> can you try one more. >> the financial accuratecy, one penny does not have as much impact as one million dollars it is looking at the accuracy of dollars paid out verses payment accuracy is looking at
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the frequency of payment errors in the sample. so, you could have a one penny error, a $10 error, and a $5, error and they are equal weight with the payment accuracy. >> could i give it back to you to make sure that i understand it. >> financial is the value of the error? >> of the dollar amount, right, exactly. >> and payment is just that an error was made. >> and any kind of payment error in the sample and so anything that is origin, it could be of any dollar size, and counts as an error. >> and over all, it is all kinds of errors, financial or payment or non-payment error and we are looking at over member experience and you can have a situation where the claim is miskeyed for a date of service. and that particular claim may pay the right amount, but it could lead to a financial error at a later date because it
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could cause the duplicate claims to be paid and such, and so over all accuracy, we are looking at the frequency of any type of error in our sample. >> thank you. >> commissioner shlain? >> in your separate, and in your, and yeah, in the separate, so you did 220 general audits and you kind of come down into the ten, high dollar ones and then ten and the instage renal ones. and so i guess, i mean, end stage renal is expensive and so, when you do ten high dollar and ten, those to me are the both the same thing and i am just wondering why. but that is not, that is just a question part a and part b, is. and you know, when you look at a pyramid, you know, the expensive things at the top of the pyramid, but they represent a large portion, and it is a small number of things that represent a portion at the bottom. but they live at the top. when you get to like the very expensive things, but when you get to the bottom, you have a lot of little things that actually add up to more than
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the top of the pyramid and i know that you did a random sampling and i wonder if you would do a sampling of the ten, not the ten, but, the conditions that cost very little, but represent a huge dollar amount as a separate slice of an audit as opposed to the ones just at the top of the pyramid. does that make sense? so you audit everything, equally and you find the things but the special audits at the top. there are no special at the bottom, meaning that these 50 dollar things that happen $5 million times and i wonder if we wouldn't do a special audit of the high frequency things and the low dollar things, because they add up to be more than the other ones. >> okay. to address the question, regarding the ten high dollar claims and the instage renal claims and those come by the
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2012 audit. and we determined some errors within esrd, as well as some high dollars, so we specifically honed in on those claims, to determine for a special targeted audit. for our general audit, our 220 claims, they are stratified claims and so we are looking at a full aspect. and we have a zero pay and so the claims that payed zero and went to the patient's deductible or denied the claims, paid a penny to 500, and so you are at a 500 to a 2500, or to $5,000, or $5,000 and above and so we look at a large, range of claims, in different conditions, as well. and the two specific conditions, in the targeted audit, again, came from our 2012 audit. >> right. >> but just to put a fine point on this and i think that you understand it, but i want to put a fine point on it, is if there are claims that are a dollar to $500, is that the low
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strata there? which one of those are the most frequent? and so of the 0 to 500 dollar claims are 50 percent of those 50 dollar claims for a specific thing? we should target those, because if, you know, just take a random sampling of those, you know, i am sure that most of the claims are 0 to $500, and that is the bulk of claims and so within those, there is probably some codes, diagnosis codes that represent the massive majority of those, and so i want to focus in on it, so if everyone is up by $5 and it happens 55,000 times and we don't audit that because it is too small and we don't appreciate the frequency that leads to a big dollar amount. >> so, it is we randomly select within the each strata, bucket but we see a lot of the most frequent claims because there is a high volume. if you look at the high volume
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of claims and normally see the physical therapy and the office claims in the universe, those are going to end up in the sample. through that random process. >> so you have your dollar strata and we have such a large portion of our selection, that are in that zero pay or the one penny to the $500 where the bulk of the universe is. so... >> yes. >> and the claim is up one. >> and yes, claim, wise. >> and i think that we can in next year's audit, we can add that. >> yeah, i think that we can actually look at that from a statistical standpoint off line. >> okay. >> thank you. >> thank you. >> in addition to our 220 claim audits, we have we also classify out of sample error, and it will be an error that was related to our sample claim. and so, the best example would
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be anxillary charge if our was a facility charge and any of the charges that may impact that charge will also be audited and if an error was found on those, that would be an out of sample error. >> and we have the results of the 2014, audit, as well as the 2012 audit so that we could compare to see the improvements by uhc and we also on the right-hand side, compare the results to the objective for the minimum level. >> and financial accuratecy and over all accuracy, did not prove in the 2014 audit. and the frequency of errors increased. and however, the dollar amount of the errors decreased by
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almost 10,000. >> in addition of the targeted claims of the 20 target td claims, 6 of the errors were due to manual ajudication and we did notify any systemic errors of the targeted claims and the next few slides we will be comparing the audit results to the passed 20 audits and completed by aon. and these are blind audits and they are not just of the uhc and they are across the board of any carrier that we have
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audited 220 claims this rements the satisfaction and the shaded red hashed line, represents where uhc fell in this year's audit. and we can see for the financial accuracy, uhc, while improved from last or from 2012, still was below our minimum satisfaction level. >> is that big, or is that little? and i don't know if someone falls in at 78 percent and that gives me a framework of how to understand this. >> well, when, this gives you an idea of the 20 most recent, and the lowest one was 97.3 percent and this is obviously changing on a weekly basis because we do so many audits but it is definitely lower than we would like to see.
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and but, we don't think that the ship is sinking, we think that they can definitely get it up to a higher level. it is just shy of one percent but you can see in this range, generally, we have all the way up to 100, and it was rare, to see below like a 97.4 and it does happen, and we have some that are significantly below, and it is not a every day thing. >> do you guys ever watch over payments and things, that actually with the benefit. >> and yeah, over payments is a big, and under payments and certainly, and we see quite a few over payments when we do our audits. we will compare with over all
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accuracy. and again, things shading where uhc did much better with over all accuracy, from improving doing better than eight of the past, since the audits that we have completed. the payment accuracy, and this is one, where uhc barely missed our standard at 9748 uhc, our standard is 9950. so, because of the frequency, of errors, just barely missed or satisfaction level. >> and here is where we get into the over payment and the under payments for the errors. and for insample we have a total of 12 errors and 9 in-sample errors and three out of sample errors. of the errors identified, four of the errors were manually
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adjudicated errors related to medicare coordination of benefit and two were related to charges that were incorrectly denied. and uhc did agree to all four of these errors and reprocessed the charges, prior to our audit and so uhc did know about these error and did correct them prior to the audit. >> we also have two errors, and regarding two out of sample errors. and regarding anxillary services for colonose co-py and they disagreed with it and uhc did recently provide additional information to their disagreement and we are in the process of rereviewing each of the errors that uhc did disagree to. >> and at the bottom of the page, we also have over payments, and the total over payments and the under payments for our in-sample claims.
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>> may i ask a question on this slide? so you said on the metrics and the nine in-sample claim errors, six were system errors they have corrected them? >> uhc is in the process of correcting, i believe that there are two left to corrects, where impact reports were being run. >> two of the errors of that were, identified were claims that were denied requesting other insurance information from medicare primary participants and uhc acknowledged that system error at the time of the response by uhc it had not been corrected. >> so it says to i guess that we will hear from uhc at some point and so as far as we are aware that error continues today. >> as far as we know that. >> okay. >> and if the over payments are 2.749, can you give us any estimate of the total impact if
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this is... and could you only, you took 220 out of whatever, the universe of claims are. >> again, we are waiting for the reporting from uhc. regarding the impact of the claims. however claims it did impact. >> okay but there sno way to give usen estimate. >> you did a sample and if you were to apply the sample to the over all universe? >> right. so, we do not extrapolate out to say that because you had this number of errors in the sample, that means that it is exactly the same in the universe, but we do work one on one with uhc, to quantify the over all financial impacts, to the universe of those systemic issues that we identified. and they run reports,


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